| Objective: To observe the intervention effect of Qigui Tangtongning Granules(QTG) on patients with Diabetic Peripheral Neuropathy(DPN) and the influence on the expression of Advanced Glycationend products(AGEs)and Poly ADP-ribose Polymerase(PARP)m RNA of sciatic nerve in rats, thus to explore the mechanism of QTG preventing and treating DPN.Methods:1. clinical research 1.1 Study Object:The study observed 64 DPN patients with deficiency of both Qi and Yin with blood stasis syndrome type,which were randomly divided into the treatment group and the control group. Both the two groups were given conventional hypoglycemic therapy plus Mecobalamin Tablets treatment. The treatment group added QTG on the basis of the control group. The observation period of the two groups was 12 weeks. 1.2 Study Methods:Respectively observed the Chinese medicine syndrome integrals,Toronto integrals and the change of EMG about nerve conduction velocity(NCV),tested the levels of patients’ Fasting Plasma Glucose(FPG), Postprandial 2h Plasma Glucose(2h PG), Glycated Hemoglobin A1c(Hb A1c), Fasting Insulin(FINS), 2h Insulin(2h INS), Total Cholesterol(TC),Triacyl Glycero(TG), Low-density Lipoprotein Cholesterol(LDL-C), High-density Lipoproteins Cholesterol(HDL-C), serum Superoxide Dismutase(SOD), Malondialdehyde(MDA), AGEs and so on,and calculated the total efficiency and assessed the therapeutic effects of two groups before and after the treatment. 2 Animal experiments 2.1 Study Object:Divided the male SD rats into the blank control group(Con group) and the modeling group, and the modeling group was prepared to be diabetic rats models.The final successful models of the rats were randomly divided into 4 groups again: the model group(M group), the Mecobalamin Tablets group(J group), the QTG high dose group(QTG high group) and the QTG low dose group(QTG low group).Each group was given medicine for 12 weeks continuously. 2.2 Study Methods:Observed general situation of each group before and after experiments respectively,and examined the levels of blood glucose in rats and the weight of the rats,detected the mechanical pain threshold and the conduction velocity of sciatic nerve in rats.The rats were killed after 12 weeks when they were fasted 12 h.Finally detected the levels of serum SOD and MDA using chemical method, tested the level of serum Nerve Growth Factor(NGF) by ELISA,and isolated sciatic nerve tissues and then tested their expression levels of AGEs and PARP m RNA by the RT-PCR method.Results:1. Clinical Study(1) After the experiment, the total effective rate of the treatment group and the control group was 86.7% and 72.4% respectively, and the efficiency of the treatment group was superior to the control group(P<0.05). Chinese medicine syndrome integrals and the Toronto integrals of the control group reduced after treatment(P<0.05),and the Chinese medicine syndrome integrals and the Toronto integrals of the treatment group were reduced obviously(P<0.01).After the treatment,there was statistical significance of the Chinese medicine syndrome integrals between the treatment group and the control group(P<0.05).(2) After the treatment, the levels of FPG, 2h PG,Hb A1 c,2h INS of two groups’ patients were both decreased significantly(P<0.05 or P<0.01).The levels of FINS of the treatment group decreased(P<0.05).The levels of 2h PG, Hb A1 c,2h INS of the treatment group were improved significantly compared with the control group(P<0.05 or P<0.01).The levels of TC, TG and LDL-C of both two groups decreased, and the difference was statistically significant(P<0.05 or P<0.01).The levels of TC,TG and LDL-C of the treatment group were lower than the control group(P<0.05 or P<0.01).The level of HDL-C of the two groups both increased,but the difference had no statistical significance(P>0.05).(3) After the treatment,the SCV and MCV of median nerves and common peroneal nerves in both two groups were both improved(P<0.05 or P<0.01).The SCV and MCV of median nerves and SCV of common peroneal nerves of the treatment group obviously improved compared with the the control group(P<0.01).(4) After the treatment,the level of SOD in the control group and the treatment group both increased(P<0.05 or P<0.01), and the difference between them had statistical significance(P<0.05). The levels of MDA and AGEs in the two groups both reduced(P<0.05 or P<0.01).There was statistically significant difference of the level of AGEs between the two groups(P<0.01). 2. Animal experimental results(1) After 12 weeks treatment, the weight of QTG high group,QTG low group and J group increased, but it was significantly lower than that of the Con group(P<0.01),and higher than that of the M group(P<0.05).(2) After the treatment, the level of FPG of M group, QTG high group,QTG low group and J group was higher than that of the Con group(P<0.01). The level of FPG of QTG high group,QTG low group and J group were lower than that of the M group(P<0.05 or P<0.01).(3)After the treatment, the mechanical pain threshold and conduction velocity of sciatic nerve of M group, QTG high group, QTG low group and J group were all lower than those of Con group(P<0.01).Those of QTG high group, QTG low group and J group were higher than those of M group(P<0.01). Those of QTG high group increased compared with J group, but the differences had no statistical significance.Those of QTG low group were lower than those of J group(P<0.05).(4)After the treatment, the level of serum SOD in M group, QTG high group,QTG low group and J group was lower than that in the Con group(P<0.01),and that in QTG high group,QTG low group and J group was increased compared with that in M group(P<0.05 or P<0.01).The level of serum MDA in M group, QTG high group,QTG low group and J group was higher than that in the Con group(P<0.01). The level of serum MDA in QTG high group,QTG low group and J group was lower than that in the M group(P<0.05).The level of serum NGF in M group, QTG high group,QTG low group and J group was lower than that in the Con group(P<0.01),and that in QTG high group,QTG low group and J group was higher than that in the M group(P<0.01 or P<0.05).(5)The expressions of AGEs and PARP m RNA of QTG high group,QTG low group and J group were all higher than those of Con group and lower than those of M group( P<0.01). The expression of AGEs m RNA of QTG high group was lower than that of J group(P<0.05), and that of QTG low group was higher than that of J group(P<0.01). The expression of PARP m RNA of QTG high group and low group were both lower than that of J group(P<0.01).Conclusion:Qigui Tangtongning Granules can significantly improve the symptoms of deficiency of Qi and Yin and stagnation of blood type in diabetic peripheral neuropathy,and improve nerve conduction velocity in a certain extent. The results reveal that the mechanism may be related to the effects of lowering blood sugar, promoting insulin secretion,suppressing the interaction of oxidative stress and the formation pathway of AGEs and PARP, regulating lipid metabolism, improving the state of oxidative stress, decreasing the expressions of AGEs and PARP m RNA, improving the structure and function injury of nerve, so as to prevent and treat diabetic peripheral neuropathy. |
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